J Neurosurg. 2023 Jul 28;140(2):552-559. doi: 10.3171/2023.5.JNS23126. Print 2024 Feb 1.
Severe traumatic brain injury (TBI) is a public health issue posing significant morbidity and mortality to afflicted patients. While the effect of time to surgery as the primary factor for survival has been extensively studied, long-term dispositional outcomes following intracranial hemorrhage evacuation have not been well described in the literature. Therefore, the aim of this study was to elicit potential prognostic factors in patients presenting with severe TBI that may have a significant impact on discharge disposition.
The authors searched the National Trauma Data Bank (NTDB) for patients included between 2010 and 2019, solely focusing on those with a Glasgow Coma Scale score ≤ 8, signifying severe TBI, and with associated intracranial hemorrhage treated via surgical intervention. Numerous characteristics were analyzed, including demographics (age, sex, race, ethnicity, payment status), discharge disposition, time to surgery, pupillary response, midline shift (> 5 mm), and postoperative inpatient complications and comorbidities. Disposition included routine discharge to home, discharge to home with home health services (HHSs), discharge to acute inpatient rehabilitation (AIR), discharge to a skilled nursing facility (SNF)/long-term acute care hospital (LTACH), and death.
The authors analyzed data on 7308 patients, 69.6% of whom were White and 11.2% of whom were Black. More young Black and Hispanic patients had severe TBI events than their matched elders, whereas more elderly White patients had severe TBI events than their matched younger counterparts. The most common disposition across all ages was SNF/LTACH. Septuagenarians and octogenarians were 12.1 and 21 times more likely, respectively, to die following a severe TBI than their younger counterparts (p < 0.001). Patients aged 18-29 were 1.7 times more likely to be discharged with HHSs (p < 0.001). Minority race/ethnicity groups were less likely to be discharged to AIR. As age increased, a patient's intensive care unit stay increased by 15 days (p < 0.001) and total hospital length of stay increased by 25 days (p < 0.001).
Neurosurgical evacuation of intracranial hemorrhage in severe TBI has variable long-term morbidity. Utilizing the largest collection of trauma data within the United States, the authors present quantitative evidence on discharge disposition. Understanding these tangible points can help neurosurgeons present potential outcomes to patients, promote preventative care, and generate tangible conversations with patients and their family members.
严重创伤性脑损伤（TBI）是一个公共卫生问题，给受影响的患者带来了重大的发病率和死亡率。虽然手术时间作为生存的主要因素的影响已经得到了广泛的研究，但颅内出血清除术后的长期处置结果在文献中尚未得到很好的描述。因此，本研究的目的是确定可能对出院处置有重大影响的、患有严重 TBI 的患者的潜在预后因素。
作者在国家创伤数据库（NTDB）中搜索了 2010 年至 2019 年期间的患者，仅关注格拉斯哥昏迷量表（GCS）评分≤8 的患者，这些患者患有严重 TBI 且伴有经手术干预的颅内出血。分析了许多特征，包括人口统计学特征（年龄、性别、种族、族裔、支付状态）、出院处置、手术时间、瞳孔反应、中线移位（＞5mm）以及术后住院并发症和合并症。出院处置包括常规出院回家、出院回家并接受家庭健康服务（HHS）、出院到急性住院康复（AIR）、出院到疗养院/长期急性护理医院（LTACH）和死亡。
作者分析了 7308 名患者的数据，其中 69.6%为白人，11.2%为黑人。与年龄较大的患者相比，年轻的黑人患者和西班牙裔患者的严重 TBI 发生率更高，而年龄较大的白人患者的严重 TBI 发生率高于年龄较小的患者。所有年龄段中最常见的出院处置都是疗养院/长期急性护理医院。与年轻患者相比，70 岁以上的患者死亡的可能性分别高出 12.1 倍和 21 倍（p<0.001）。18-29 岁的患者出院时接受 HHS 的可能性高 1.7 倍（p<0.001）。少数民族种族/族裔群体出院到 AIR 的可能性较低。随着年龄的增长，患者在重症监护病房的停留时间增加了 15 天（p<0.001），总住院时间增加了 25 天（p<0.001）。
神经外科手术清除颅内出血治疗严重 TBI 具有不同的长期发病率。作者利用美国最大的创伤数据集合，提供了关于出院处置的定量证据。了解这些具体情况可以帮助神经外科医生向患者展示潜在的结果，促进预防保健，并与患者及其家属进行切实可行的对话。
